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Personalized smoking environment cue reactivity in smokers with schizophrenia and controls: A pilot study
Psychiatry Research 188 (2011) 286–288
Contents lists available at ScienceDirect
Psychiatry Research j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / p s yc h r e s
Brief report
Personalized smoking environment cue reactivity in smokers with schizophrenia and controls: A pilot study Christopher G. AhnAllen ⁎, Jennifer W. Tidey Center for Alcohol and Addictions Studies, Alpert Medical School of Brown University, Providence, RI, United States
a r t i c l e
i n f o
Article history: Received 30 September 2010 Received in revised form 28 March 2011 Accepted 12 April 2011 Keywords: Cigarette smoking Schizophrenia Nicotine
a b s t r a c t Exposure to smoking cues increases craving to smoke and negatively changes mood in smokers with schizophrenia (SWS). This pilot study compared reactivity to real-world smoking environments versus neutral environments in SWS (n = 10) and non-psychiatric control smokers (CON; n = 10). Results indicate that both SWS and CON experienced increases in smoking urges when viewing images of their smoking environments and that SWS tended to report greater increases in withdrawal-related negative mood than CON when viewing images of their smoking environments. These findings signify that personalized smoking environments trigger smoking urges in SWS and suggest that extinguishing this reactivity may aid cessation efforts in this population. © 2011 Elsevier Ireland Ltd. All rights reserved.
Tobacco dependence is pervasive and difficult to treat in smokers with schizophrenia (SWS; Ziedonis et al., 2008). Identification of factors that precipitate smoking in SWS may help to improve treatment outcomes. One such factor is exposure to smoking-related stimuli (cues), which increases urge to smoke due to frequent associations over time between cues and nicotine effects (Carter and Tiffany, 1999). Furthermore, neurobiological deficits associated with schizophrenia may sensitize these individuals to the reinforcing effects of drugs and strengthen drug-cue associations (Chambers et al., 2001). Although previous studies have identified similarly strong urge responses to non-personalized smoking cues in SWS and non-psychiatric smokers (Fonder et al., 2005; Tidey et al., 2005; 2008), images of personalized real-world smoking environments may be more vivid and relevant than non-personalized cues (Conklin et al., 2010). This pilot study compared reactivity to personalized smoking environment cues in SWS and control smokers without psychiatric illness (CON). We hypothesized that SWS would have heightened cue reactivity compared to CON.
schizoaffective disorder were confirmed. CON participants had no current or past Axis I disorder, and no first-degree relative with schizophrenia or schizoaffective disorder. After reporting the number of cigarettes and time spent smoking in locations where they typically smoke, participants were trained to use digital cameras to capture pictures of four primary smoking environments and four nonsmoking environments. Faces and smoking paraphernalia were excluded from all pictures. Reactivity to these images was tested in a separate session. Participants smoked a cigarette upon arrival at the laboratory. After a 10-min relaxation period, participants viewed their smoking and non-smoking images in separate sessions, with cue set order balanced across participants and a 10-min relaxation period between sets. Each cue set consisted of 8 images, two from each environment, presented on a laptop computer for 30 s each. Participants were asked to concentrate on each image and imagine being in the environment. Before and after cue exposure, smoking urge was measured with the item “How strong is your urge to smoke a cigarette right now?” (0 = “No urge at all” to 10 = “Strongest urge you've ever had”), which is sensitive to cues in SWS (Tidey et al., 2005; 2008), and withdrawal-related negative mood was measured with the Minnesota Nicotine Withdrawal Scale (MNWS; Hughes and Hatsukami, 1986), which has been validated in SWS (Weinberger et al., 2007). The insomnia item was omitted from the scale. Chi-square and one-way analysis of variance (ANOVA) tests were used to conduct between-groups comparisons. Urge and MNWS change scores (post-cue scores minus pre-cue scores) were analyzed using 2 × 2 × 2 (Group × Cue Order × Cue Type) mixedmodel repeated measures ANOVAs. Effect sizes (η2) are reported for non-significant tests (η2 ≤ 0.05, small; η2 = 0.06–0.14, medium; η2 ≥ 0.15, large effects).
2. Methods
3. Results
1. Introduction
Participants, recruited from the community, were 18+ years old, smoked 20+ cigarettes per day and scored ≥ 6 on a modified Fagerström Test of Nicotine Dependence (FTND; Steinberg et al., 2005). Psychiatric diagnoses (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; DSM-IV) of schizophrenia or ⁎ Corresponding author at: Inpatient Mental Health Service, Ward 23B, VA Boston Healthcare System, Brockton, MA 02301, United States. Tel.: + 1 774 826 1007; fax: + 1 774 826 3217. E-mail address: [email protected] (C.G. AhnAllen). 0165-1781/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.psychres.2011.04.005
Ten SWS and 10 CON enrolled in and completed this study. Demographic and smoking variables did not differ between groups (Table 1). Neither group had difficulty using the digital camera. Participants in both groups reported that the majority of daily cigarettes were smoked in the living room, porch/yard, kitchen and bedroom (SWS = 99%, CON = 94%). On an average day, SWS spent 14.1 ± 5.0 (M ± S.D.) h and smoked 29.8 ± 14.2 cigarettes and CON spent 11.9 ± 5.7 h and smoked 23.2 ± 10.7 cigarettes in one of these
C.G. AhnAllen, J.W. Tidey / Psychiatry Research 188 (2011) 286–288
287
Table 1 Participant characteristics and cue reactivity change scores, M (S.D.) or %.
Gender (% female) Age (years) Education (years) Hispanic ethnicity (%) European American (%) African American (%) Native American/Alaskan (%) Currently Married (%) Employed full- or part-time (%) Cigarettes per day Nicotine dependence score (FTND) PANSS positive PANSS negative PANSS general Antipsychotic medication
Single-item urge MNWS negative mood
Schizophrenia (n = 10)
Control (n = 10)
20 44.5 (5.1) 10.8 (1.9) 0 80 10 10 10 10 30.1 (9.3) 7.60 (1.6) 10.40 (2.6) 10.50 (3.9) 22.30 (6.0) 80% atypical, 20% typical
40 52.6 (13.4) 11.7 (2.3) 0 60 40 0 20 30 24.8 (7.4) 6.80 (1.3)
Smoke 9.0 (12.0) 0.32 (0.68)
Neutral − 4.0 (13.5) − 0.04 (0.42)
Smoke Smoke 12.0 (16.2) − 0.02 (0.25)
Neutral 0.0 (12.5) 0.05 (0.22)
Note: Change scores are calculated by subtracting the pre-cue condition from the post-cue condition. FTND, Fagerström Test of Nicotine Dependence; PANSS, Positive and Negative Syndrome Scale; MNWS, Minnesota Nicotine Withdrawal Scale, MAP, Mean arterial pressure.
environments. SWS reported smoking more cigarettes in their primary smoking environment (14.40 ± 7.8) than CON (8.60 ± 3.1; F (1, 18) = 4.83, p b 0.05). Pre-cue urge scores were not different between groups (SWS: 44.5 ± 19.9; CON: 41.0 ± 16.5). Smoking cues, but not neutral cues, significantly increased urge to smoke across groups (F (1, 16) = 8.17, p = 0.01). MNWS scores differed between groups (SWS: 1.18 ± 0.79; CON: 0.42 ± 0.60; F (1, 18) = 5.86, p b 0.05). A trend-level Cue Type × Group interaction on MNWS score suggested that, in SWS but not CON, smoking cues tended to increase MNWS score whereas neutral cues did not (F (1, 16) = 2.86, p = 0.11, η2 = 0.15). A significant Cue Type × Order on MNWS score indicated that MNWS scores increased following presentation of the first cue set when smoking cues were presented first (F (1, 16) = 6.07, p b 0.05). No other main effects or interactions among variables were observed.
increases in urge in response to smoking cues but not neutral cues support the validity of these findings. As SWS smoked more of their daily cigarettes in their primary smoking location than controls, future studies may investigate whether smoking relapse occurs more frequently in the primary smoking environment in SWS compared to CON. Future studies should also investigate whether extinguishing reactivity to real-world smoking contexts aids cessation efforts (Gunther et al., 1998). Extinction training in SWS may be easier to accomplish given that only a small group of environments account for the vast majority of cigarette use. Acknowledgments This study was supported by R01-DA14002 to JWT and a Research Excellence Award from the Brown University Center for Alcohol and Addictions Studies to CGA. We thank Laura Dionne for data management assistance, Netesha Reid and Amy Adolfo for technical support and the study participants for their contributions.
4. Discussion In this first study of reactivity to personalized smoking environment cues in SWS, images of smoking environments increased smoking urges, thus extending the findings of Conklin et al. (2010) to SWS. Results indicate that urge responses of SWS to cues are similar to those of non-psychiatric smokers, as seen previously with nonpersonalized cues (Fonder et al., 2005; Tidey et al., 2005; 2008). SWS also tended to respond to smoking cues with increases in MNWS score. SWS report reduction of negative affect as their most important smoking expectancy (Tidey and Rohsenow, 2009). Furthermore, preliminary evidence indicates that SWS experience greater negative mood and greater urge to smoke to reduce negative mood than CON during continuous 72-h smoking abstinence (Tidey and Colby, 2011), suggesting that negative mood may be a more significant antecedent of smoking in SWS than in CON. Limitations of this study include its small sample size and majority European-American male sample. Furthermore, counterbalancing cue order resulted in carry-over of subjective effects induced by the smoking cues, as noted previously (Monti et al., 1987). Finally, the task required imagining oneself in the environment, an ability that may be impaired in schizophrenia. However, images of real-world smoking environments, tailored for each smoker, may be more vivid and relevant than nonpersonalized cues (Conklin et al., 2010). Furthermore, the specific
References Carter, B.L., Tiffany, S.T., 1999. Meta-analysis of cue-reactivity in addiction research. Addiction 94, 327–340. Chambers, R.A., Krystal, J.H., Self, D.W., 2001. A neurobiological basis for substance use comorbidity in schizophrenia. Biological Psychiatry 15, 71–83. Conklin, C.A., Perkins, K.A., Robin, N., McClernon, F.J., Salkeld, R.P., 2010. Bringing the real world into the laboratory: personal smoking and nonsmoking environments. Drug and Alcohol Dependence 111, 58–63. Fonder, M.A., Sacco, K.A., Termine, A., Boland, B.S., Seyal, A.A., Dudas, M.M., Vessicchio, J.C., George, T.P., 2005. Smoking cue reactivity in schizophrenia: effects of a nicotinic receptor antagonist. Biological Psychiatry 57, 802–808. Gunther, L.M., Denniston, J.C., Miller, R.R., 1998. Conducting exposure treatment in multiple contexts can prevent relapse. Behaviour Research and Therapy 36, 75–91. Hughes, J.R., Hatsukami, D., 1986. Signs and symptoms of tobacco withdrawal. Archives of General Psychiatry 43, 289–294. Monti, P.M., Binkoff, J.A., Abrams, D.B., Zwick, W.R., Nirenberg, T.D., Liepman, M.R., 1987. Reactivity of alcoholics and nonalcoholics to drinking cues. Journal of Abnormal Psychology 96, 1–5. Steinberg, M.L., Williams, J.M., Steinberg, H.R., Krejci, J.A., Ziedonis, D.M., 2005. Applicability of the Fagerström test for nicotine dependence in smokers with schizophrenia. Addictive Behaviors 30, 49–59. Tidey, J.W., Colby, S.M., 2011. Characterization of 72-hr abstinence effects in smokers with schizophrenia and controls. Paper presented at the annual meeting of the Society for Research on Nicotine and Tobacco, Toronto, Canada. Tidey, J.W., Rohsenow, D.J., 2009. Smoking expectancies and intention to quit in smokers with schizophrenia, schizoaffective disorder and non-psychiatric controls. Schizophrenia Research 115, 310–316.
288
C.G. AhnAllen, J.W. Tidey / Psychiatry Research 188 (2011) 286–288
Tidey, J.W., Rohsenow, D.J., Kaplan, G.B., Swift, R.M., 2005. Subjective and physiological responses to smoking cues in smokers with schizophrenia. Nicotine & Tobacco Research 7, 421–429. Tidey, J.W., Rohsenow, D.J., Kaplan, G.B., Swift, R.M., Adolfo, A.B., 2008. Effects of smoking abstinence, smoking cues and nicotine replacement in smokers with schizophrenia versus controls. Nicotine & Tobacco Research 10, 1047–1056. Weinberger, A.H., Sacco, K.A., Creeden, C.L., Vessicchio, J.C., Jatlow, P.I., George, T.P., 2007. Effects of acute abstinence, reinstatement, and mecamylamine on biochem-
ical and behavioral measures of cigarette smoking in schizophrenia. Schizophrenia Research 91, 217–225. Ziedonis, D., Htsman, B., Beckham, J., Zvolensky, M., Adler, L., Audrain-McGovern, J., Breslau, N., Brown, R., George, T., Williams, J., Calhoun, P., Riley, W., 2008. Tobacco use and cessation in psychiatric disorders: National Institute on Mental Health report. Nicotine & Tobacco Research 10, 1691–1715.
Contents lists available at ScienceDirect
Psychiatry Research j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / p s yc h r e s
Brief report
Personalized smoking environment cue reactivity in smokers with schizophrenia and controls: A pilot study Christopher G. AhnAllen ⁎, Jennifer W. Tidey Center for Alcohol and Addictions Studies, Alpert Medical School of Brown University, Providence, RI, United States
a r t i c l e
i n f o
Article history: Received 30 September 2010 Received in revised form 28 March 2011 Accepted 12 April 2011 Keywords: Cigarette smoking Schizophrenia Nicotine
a b s t r a c t Exposure to smoking cues increases craving to smoke and negatively changes mood in smokers with schizophrenia (SWS). This pilot study compared reactivity to real-world smoking environments versus neutral environments in SWS (n = 10) and non-psychiatric control smokers (CON; n = 10). Results indicate that both SWS and CON experienced increases in smoking urges when viewing images of their smoking environments and that SWS tended to report greater increases in withdrawal-related negative mood than CON when viewing images of their smoking environments. These findings signify that personalized smoking environments trigger smoking urges in SWS and suggest that extinguishing this reactivity may aid cessation efforts in this population. © 2011 Elsevier Ireland Ltd. All rights reserved.
Tobacco dependence is pervasive and difficult to treat in smokers with schizophrenia (SWS; Ziedonis et al., 2008). Identification of factors that precipitate smoking in SWS may help to improve treatment outcomes. One such factor is exposure to smoking-related stimuli (cues), which increases urge to smoke due to frequent associations over time between cues and nicotine effects (Carter and Tiffany, 1999). Furthermore, neurobiological deficits associated with schizophrenia may sensitize these individuals to the reinforcing effects of drugs and strengthen drug-cue associations (Chambers et al., 2001). Although previous studies have identified similarly strong urge responses to non-personalized smoking cues in SWS and non-psychiatric smokers (Fonder et al., 2005; Tidey et al., 2005; 2008), images of personalized real-world smoking environments may be more vivid and relevant than non-personalized cues (Conklin et al., 2010). This pilot study compared reactivity to personalized smoking environment cues in SWS and control smokers without psychiatric illness (CON). We hypothesized that SWS would have heightened cue reactivity compared to CON.
schizoaffective disorder were confirmed. CON participants had no current or past Axis I disorder, and no first-degree relative with schizophrenia or schizoaffective disorder. After reporting the number of cigarettes and time spent smoking in locations where they typically smoke, participants were trained to use digital cameras to capture pictures of four primary smoking environments and four nonsmoking environments. Faces and smoking paraphernalia were excluded from all pictures. Reactivity to these images was tested in a separate session. Participants smoked a cigarette upon arrival at the laboratory. After a 10-min relaxation period, participants viewed their smoking and non-smoking images in separate sessions, with cue set order balanced across participants and a 10-min relaxation period between sets. Each cue set consisted of 8 images, two from each environment, presented on a laptop computer for 30 s each. Participants were asked to concentrate on each image and imagine being in the environment. Before and after cue exposure, smoking urge was measured with the item “How strong is your urge to smoke a cigarette right now?” (0 = “No urge at all” to 10 = “Strongest urge you've ever had”), which is sensitive to cues in SWS (Tidey et al., 2005; 2008), and withdrawal-related negative mood was measured with the Minnesota Nicotine Withdrawal Scale (MNWS; Hughes and Hatsukami, 1986), which has been validated in SWS (Weinberger et al., 2007). The insomnia item was omitted from the scale. Chi-square and one-way analysis of variance (ANOVA) tests were used to conduct between-groups comparisons. Urge and MNWS change scores (post-cue scores minus pre-cue scores) were analyzed using 2 × 2 × 2 (Group × Cue Order × Cue Type) mixedmodel repeated measures ANOVAs. Effect sizes (η2) are reported for non-significant tests (η2 ≤ 0.05, small; η2 = 0.06–0.14, medium; η2 ≥ 0.15, large effects).
2. Methods
3. Results
1. Introduction
Participants, recruited from the community, were 18+ years old, smoked 20+ cigarettes per day and scored ≥ 6 on a modified Fagerström Test of Nicotine Dependence (FTND; Steinberg et al., 2005). Psychiatric diagnoses (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; DSM-IV) of schizophrenia or ⁎ Corresponding author at: Inpatient Mental Health Service, Ward 23B, VA Boston Healthcare System, Brockton, MA 02301, United States. Tel.: + 1 774 826 1007; fax: + 1 774 826 3217. E-mail address: [email protected] (C.G. AhnAllen). 0165-1781/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.psychres.2011.04.005
Ten SWS and 10 CON enrolled in and completed this study. Demographic and smoking variables did not differ between groups (Table 1). Neither group had difficulty using the digital camera. Participants in both groups reported that the majority of daily cigarettes were smoked in the living room, porch/yard, kitchen and bedroom (SWS = 99%, CON = 94%). On an average day, SWS spent 14.1 ± 5.0 (M ± S.D.) h and smoked 29.8 ± 14.2 cigarettes and CON spent 11.9 ± 5.7 h and smoked 23.2 ± 10.7 cigarettes in one of these
C.G. AhnAllen, J.W. Tidey / Psychiatry Research 188 (2011) 286–288
287
Table 1 Participant characteristics and cue reactivity change scores, M (S.D.) or %.
Gender (% female) Age (years) Education (years) Hispanic ethnicity (%) European American (%) African American (%) Native American/Alaskan (%) Currently Married (%) Employed full- or part-time (%) Cigarettes per day Nicotine dependence score (FTND) PANSS positive PANSS negative PANSS general Antipsychotic medication
Single-item urge MNWS negative mood
Schizophrenia (n = 10)
Control (n = 10)
20 44.5 (5.1) 10.8 (1.9) 0 80 10 10 10 10 30.1 (9.3) 7.60 (1.6) 10.40 (2.6) 10.50 (3.9) 22.30 (6.0) 80% atypical, 20% typical
40 52.6 (13.4) 11.7 (2.3) 0 60 40 0 20 30 24.8 (7.4) 6.80 (1.3)
Smoke 9.0 (12.0) 0.32 (0.68)
Neutral − 4.0 (13.5) − 0.04 (0.42)
Smoke Smoke 12.0 (16.2) − 0.02 (0.25)
Neutral 0.0 (12.5) 0.05 (0.22)
Note: Change scores are calculated by subtracting the pre-cue condition from the post-cue condition. FTND, Fagerström Test of Nicotine Dependence; PANSS, Positive and Negative Syndrome Scale; MNWS, Minnesota Nicotine Withdrawal Scale, MAP, Mean arterial pressure.
environments. SWS reported smoking more cigarettes in their primary smoking environment (14.40 ± 7.8) than CON (8.60 ± 3.1; F (1, 18) = 4.83, p b 0.05). Pre-cue urge scores were not different between groups (SWS: 44.5 ± 19.9; CON: 41.0 ± 16.5). Smoking cues, but not neutral cues, significantly increased urge to smoke across groups (F (1, 16) = 8.17, p = 0.01). MNWS scores differed between groups (SWS: 1.18 ± 0.79; CON: 0.42 ± 0.60; F (1, 18) = 5.86, p b 0.05). A trend-level Cue Type × Group interaction on MNWS score suggested that, in SWS but not CON, smoking cues tended to increase MNWS score whereas neutral cues did not (F (1, 16) = 2.86, p = 0.11, η2 = 0.15). A significant Cue Type × Order on MNWS score indicated that MNWS scores increased following presentation of the first cue set when smoking cues were presented first (F (1, 16) = 6.07, p b 0.05). No other main effects or interactions among variables were observed.
increases in urge in response to smoking cues but not neutral cues support the validity of these findings. As SWS smoked more of their daily cigarettes in their primary smoking location than controls, future studies may investigate whether smoking relapse occurs more frequently in the primary smoking environment in SWS compared to CON. Future studies should also investigate whether extinguishing reactivity to real-world smoking contexts aids cessation efforts (Gunther et al., 1998). Extinction training in SWS may be easier to accomplish given that only a small group of environments account for the vast majority of cigarette use. Acknowledgments This study was supported by R01-DA14002 to JWT and a Research Excellence Award from the Brown University Center for Alcohol and Addictions Studies to CGA. We thank Laura Dionne for data management assistance, Netesha Reid and Amy Adolfo for technical support and the study participants for their contributions.
4. Discussion In this first study of reactivity to personalized smoking environment cues in SWS, images of smoking environments increased smoking urges, thus extending the findings of Conklin et al. (2010) to SWS. Results indicate that urge responses of SWS to cues are similar to those of non-psychiatric smokers, as seen previously with nonpersonalized cues (Fonder et al., 2005; Tidey et al., 2005; 2008). SWS also tended to respond to smoking cues with increases in MNWS score. SWS report reduction of negative affect as their most important smoking expectancy (Tidey and Rohsenow, 2009). Furthermore, preliminary evidence indicates that SWS experience greater negative mood and greater urge to smoke to reduce negative mood than CON during continuous 72-h smoking abstinence (Tidey and Colby, 2011), suggesting that negative mood may be a more significant antecedent of smoking in SWS than in CON. Limitations of this study include its small sample size and majority European-American male sample. Furthermore, counterbalancing cue order resulted in carry-over of subjective effects induced by the smoking cues, as noted previously (Monti et al., 1987). Finally, the task required imagining oneself in the environment, an ability that may be impaired in schizophrenia. However, images of real-world smoking environments, tailored for each smoker, may be more vivid and relevant than nonpersonalized cues (Conklin et al., 2010). Furthermore, the specific
References Carter, B.L., Tiffany, S.T., 1999. Meta-analysis of cue-reactivity in addiction research. Addiction 94, 327–340. Chambers, R.A., Krystal, J.H., Self, D.W., 2001. A neurobiological basis for substance use comorbidity in schizophrenia. Biological Psychiatry 15, 71–83. Conklin, C.A., Perkins, K.A., Robin, N., McClernon, F.J., Salkeld, R.P., 2010. Bringing the real world into the laboratory: personal smoking and nonsmoking environments. Drug and Alcohol Dependence 111, 58–63. Fonder, M.A., Sacco, K.A., Termine, A., Boland, B.S., Seyal, A.A., Dudas, M.M., Vessicchio, J.C., George, T.P., 2005. Smoking cue reactivity in schizophrenia: effects of a nicotinic receptor antagonist. Biological Psychiatry 57, 802–808. Gunther, L.M., Denniston, J.C., Miller, R.R., 1998. Conducting exposure treatment in multiple contexts can prevent relapse. Behaviour Research and Therapy 36, 75–91. Hughes, J.R., Hatsukami, D., 1986. Signs and symptoms of tobacco withdrawal. Archives of General Psychiatry 43, 289–294. Monti, P.M., Binkoff, J.A., Abrams, D.B., Zwick, W.R., Nirenberg, T.D., Liepman, M.R., 1987. Reactivity of alcoholics and nonalcoholics to drinking cues. Journal of Abnormal Psychology 96, 1–5. Steinberg, M.L., Williams, J.M., Steinberg, H.R., Krejci, J.A., Ziedonis, D.M., 2005. Applicability of the Fagerström test for nicotine dependence in smokers with schizophrenia. Addictive Behaviors 30, 49–59. Tidey, J.W., Colby, S.M., 2011. Characterization of 72-hr abstinence effects in smokers with schizophrenia and controls. Paper presented at the annual meeting of the Society for Research on Nicotine and Tobacco, Toronto, Canada. Tidey, J.W., Rohsenow, D.J., 2009. Smoking expectancies and intention to quit in smokers with schizophrenia, schizoaffective disorder and non-psychiatric controls. Schizophrenia Research 115, 310–316.
288
C.G. AhnAllen, J.W. Tidey / Psychiatry Research 188 (2011) 286–288
Tidey, J.W., Rohsenow, D.J., Kaplan, G.B., Swift, R.M., 2005. Subjective and physiological responses to smoking cues in smokers with schizophrenia. Nicotine & Tobacco Research 7, 421–429. Tidey, J.W., Rohsenow, D.J., Kaplan, G.B., Swift, R.M., Adolfo, A.B., 2008. Effects of smoking abstinence, smoking cues and nicotine replacement in smokers with schizophrenia versus controls. Nicotine & Tobacco Research 10, 1047–1056. Weinberger, A.H., Sacco, K.A., Creeden, C.L., Vessicchio, J.C., Jatlow, P.I., George, T.P., 2007. Effects of acute abstinence, reinstatement, and mecamylamine on biochem-
ical and behavioral measures of cigarette smoking in schizophrenia. Schizophrenia Research 91, 217–225. Ziedonis, D., Htsman, B., Beckham, J., Zvolensky, M., Adler, L., Audrain-McGovern, J., Breslau, N., Brown, R., George, T., Williams, J., Calhoun, P., Riley, W., 2008. Tobacco use and cessation in psychiatric disorders: National Institute on Mental Health report. Nicotine & Tobacco Research 10, 1691–1715.